This K-23 award will provide an opportunity for Dr. Kross to become an independent physician scientist focused on improving long-term outcomes for patients with acute lung injury. Through her patient-oriented research proposal, Dr. Kross will identify modifiable critical care risk factors for psychological and functional morbidity among patients with acute lung injury and their family members. Importantly, in order to develop innovative approaches for intervention, she will also evaluate a novel hypothesis of psychological and functional morbidity shared between patients experiencing critical illness and critical care therapies and their families. With the goal of developing a career studying therapies and outcomes for patients with acute lung injury, as well as their families, Dr. Kross proposes an integrated curriculum consisting of practical experience in designing, conducting and publishing clinical research projects; coursework in epidemiology, biostatistics and health services research; and intensive mentoring by experts in the psychological and functional outcomes of critical illness. Dr. Kross will use this K23 award to become an independently funded clinical investigator with skills in the design and conduct of clinical studies of patients with acute lung injury and their families. Moreover, she will develop expertise in survey-based outcome assessment, standardized medical record abstraction, clustered and longitudinal statistical methods, and qualitative data collection and analysis. This career development plan will lead to a successful and independent research career focused on understanding and improving long-term outcomes of acute lung injury. To achieve these goals Dr. Kross will conduct a prospective cohort study to: 1) identify associations between modifiable critical care predictors of psychological and functional morbidity for patients with acute lung injury; 2) identify associations between modifiable critical care predictors of psychological and functional morbidity for families of patients of acute lung injury; 3) identify associations between psychological and functional morbidity for patients surviving acute lung injury and psychological and functional morbidity for their families; and 4) use qualitative methods to explore potential critical care approaches to interventions that will improve long-term outcomes for patients and their families. This project has important implications for patients with acute lung injury and their families. The identification of modifiable critical care risk factors for long-term psychological symptoms and decreased functional status for both patients with acute lung injury and their families will inform the development of future critical care interventions to reduce these consequences of acute lung injury.